Services

HMO Capitated Arrangements

•  Risk Contract
• Partial Risk Profit Sharing
• Non-Risk Profit Sharing
• Non-Risk

HMO Fee-For-Service Arrangements

PPO Fee-For-Service Arrangements

ACO – Accountable Care Organization

Fee-For-Service Arrangements

• Profit Sharing Arrangements

Pre-Paid Health Plan Arrangements

• Fee-For-Service
• Fixed Cost Arrangements

Discount Medical Plan Organization Arrangements

• Fee-For-Service
• Fixed Cost Arrangements

Our goal is to provide the highest level of quality credentialing services.  We offer the opportunity to outsource the credentialing process, providing exemplary services and outstanding turn-around time.

• Concentrate time on patient care instead of credentialing headaches.
• Eliminate redundant paperwork and errors.
• Relieve valuable staff of the tedious credentialing process
• Gain access to preferred insurance networks quickly and efficiently with our specialized credentialing services.

Provider Credentialing Application Services:

We will gather all the require information and documents to assure proper credentialing for all health pans.

We offer CAQH Services:

•  We will obtain your CAQH ID and complete the online application.
• Annual CAQH on-going required re-attestation
• CAQH continuous provider updating

The healthcare industry is continuously changing. This makes is very difficult for the healthcare provider to stay up to date with all the changes. Our goal is to continuously educate the healthcare providers.

• Educating participating providers on the Management Companies, Health Plans, ACO, and Pre-Paid Health Plan policies and procedures.
• Educating Physician and/or Medical Group on the Financial Relationship between the parties.
• Health Plan, ACO, Pre-Paid Health Plan, and Government Compliance
• Servicing and resolving complaints and all provider issues
• Project Management
• Provider Data Management
• Benefit Management

There are so many options available to today’s healthcare executive regarding the exploding technology market and advances in Revenue Cycle Management (RCM). Since 2002, CareNational has been providing quality management services healthcare providers. The foundation of our success is our ability to understand the needs of clients and to adapt to this ever changing environment.

The Healthcare Management System (“HMS”) includes features and modules generally missing from ‘core’ systems.  It is an integrated system presented through a single, seamless user interface portal, enhancing efficiency and productivity, and reducing third-party applications, clearinghouse fees, and internal administrative expenses, and can work in conjunction with EMR applications today. HMS highlights the extensive use of user-configurable dashboards and a complete set of analytical and profitability reports with complete drill-down and drill-up capabilities.

Listed below are a few of the modules and integrated features included in HMS:

• Financial Analytics & Profitability Reporting
• Customer Service
• Utilization/Clinical Management
  • ICD-10; and 5010 Compliant
  • Referral/Authorization Management
  • Inpatient Management
  • Outpatient Case Management
  • Case Auto-referral
  • Clinical Guidelines Interface
  • Clinical Alerts
• System & User Defined Configuration
• Communications & Tracking
• Claims Processing
  • OCR engine integration
  • Auto-Adjudication
  • EDI
  • Batch Reprocessing
  • Workflow
  • Provider Dispute Resolution (PDR)
• Credentialing
• Eligibility
• Capitation
  • Efficient Capitation Processing with ‘Roll-Back’ Capability
  • Capitation Revenue Import and Capitation Reconciliation
• EDI Capabilities – built–in to the relevant modules, not a separate application
  • Eligibility file mapping and import
  • HIPAA standard file imports
  • 837 inbound and outbound (Encounter Reporting)
  • 835 outbound
  • Electronic Funds Transfer (EFT)
• Fax Server integration
• Complete Internal and Health Plan Reporting (timeliness, paid claims, ER utilization, denials, etc.)
• Letter Generation (UM & Claims)
• Document Management
• EMR Integration
• Portals – User Selectable Dashboards
  • Staff
  • Providers
  • Health Plan
  • Mobile device access (e.g. iPhone)

All of the modules and features of HMS have been designed to help staff work with greater automation and efficiency.

Practice Management  assistance to the practice assures that the medical providers and medical centers, begins adapting best practices protocols, while setting the way for Patient-Centered Medical Homes.  Assisting the practices with job descriptions, implementation, hiring and training is critical to best practice evolution.

First thing to do is an in depth analysis of all the personnel to make sure there are no holes.  The opportunity is at hand now to re-engineer, or tweak the operational processes to build on the right foundation.  It all starts with professional administration in order to set-up and implement basic business operational systems. This will allow for an auditable balance of inputs (revenue collections) and outputs (payment of verifiable A/P). This leads to on the spot measurement of business performance; once this is in place it requires minimal on-going maintenance to make sure all systems are up kept, working and adapting to industry business changes.  This will also set a benchmark for practice value prior to bringing in new business, as well as trending measures for future acquisition potential.

The second step, (although a lot of this is done simultaneously) is to fine-tune the practice management operations. This is where the hard work comes in since all the changes affect your current way of doing business, and providers are sub-consciously responsible for some of the problems currently afflicting the practice. Therefore, in order to achieve maximum results they would need to be open to changes and commit to run the practice as a business.  We also assist in the areas of Risk Management and HIPPA security implementation.

Referral Management is vital in order to retain a higher portion of the US dollar spent on healthcare. Without the centralization process, there is no upside business opportunity.  CareNational will allow quickly organizing and integrating multi-specialty providers as well as ancillary providers that can significantly save and increase revenue as well as produce cost reduction by achieving economies of scale, through the centralization process. 

Providers are the main billable unit of the practice, the quality of service provided to patients is currently dwarfed by the lack of sophistication from practice managers, systems, and end users; this gets further aggravated by the lack of resources to assure maximum utilization of providers. CareNational expertise in practice management will increase productivity as well as patient satisfaction with regards to waiting time. CareNational centralized call center can assure patients are adequately serviced.

By deploying and adapting care and disease management protocols we can reduce unnecessary visits, usually caused by re-work, duplication, incomplete visits or lack of documentation, which upsets patients and reduces productivity on Managed Care population.  On the other side, the quality care applied to fee for service plans, adds predictable visits that increase revenue. 

Medicare Advantage Coding is a must in order to insure maximum MRA scores on each patient,  however the integration of quality measures required by CMS through HEDIS and 5 Star Rating has revolutionized the process requiring expert coding and expert system in order to stay compliant. Our managed care coding program is second to none. 

Our comprehensive approach can not only make the medical provider and/or medical facility a top of the class medical provider but it can dramatically increase the bottom line.

• Home Telehealth (HT) technology provides a tool for patients to take an active role in the management of their chronic diseases
• HT works by allowing patients to transmit vital health data from their home to physicians’ offices and, in turn, receive health coaching
• HT system consists of a standalone hub that collects physiologic data from peripheral devices and connects the patient via interactive/audio/video capabilities. 
• TeleHealth Solutions offers the following peripherals and services for HT monitoring:
  • Vital signs (Blood Pressure, Pulse, weight/Body mass index (BMI), Pulse Ox.)
  • Cardiac Monitoring
  • Diabetes Monitoring (glucose and HgA1C)
  • Medication Management
  • Pain, Stress and Mood Management
  • Video Conferencing